Provider Demographics
NPI:1437210564
Name:LANDIS, HERBERT E (LCSW)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:E
Last Name:LANDIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6401
Mailing Address - Country:US
Mailing Address - Phone:717-560-9969
Mailing Address - Fax:717-560-9553
Practice Address - Street 1:1803 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6401
Practice Address - Country:US
Practice Address - Phone:717-560-9969
Practice Address - Fax:717-560-9553
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0133501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
097596GHEMedicare ID - Type Unspecified